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Congress considers bill to protect fetuses
Spain overhauls palliative-care plan
T
he Spanish Senate approved a motion on Sept 14 to expand its national palliative-care plan. The initiative was put forward by Enrique Bellido, president of the Senate Health Commission and a senator from the ruling Partido Popular party, who said that palliative care should erase from medical vocabulary the phrase that “there is nothing else to do for the patient”. When emphasising the necessity of such a plan to the Senate, Bellido noted that “current demographic and morbidity indicators foresee an increase in the number of patients with cancer and with chronic and degenerative pathologies mainly due to the progressively older age of the population”. The new plan will principally be based on guaranteeing palliative care for the terminally ill “in any place, circumstance, or situation, through appropriate health care, psychological, and social support and with no distinction of disease or actuation field”, said Bellido. The Partido Popular party agreed that it was also necessary to coordinate health care and social services so that palliative care is carried out mainly in patients’ homes, which are regarded as the best place to control a patient’s clinical outcome and treatment. Bellido noted that alongside health and social advantages, the plan should lead to important savings, such as a 75% decrease in the flow of such patients to emergency wards and a 50% decrease in their mean hospital stay. The reforms will also include better training aimed at different levels of health-care professionals, social workers, and patients’ families. Most senators agreed that palliative care would have to be considered a separate academic discipline because current training is insufficient. When the motion was approved, Coral Rodríguez senator of the Socialist Party immediately presented an amendment declaring that the plans constituted “an unusual discrediting” of the recently formed Special Commission for the Study of Euthanasia. The motion is now awaiting final approval from the government. Xavier Bosch
THE LANCET • Vol 354 • September 25, 1999
Congress considers bill to protect fetuses abortion-rights supporters—and the o the distress of supporters of Clinton administration—say that abortion rights, a key committee although they would back stronger of the US House of Representatives penalties for assaults on pregnant approved a bill on Sept 14 that would women, that can provide legal probe accomplished tections to fetuses without giving independent of legal rights to the those of the fetus. pregnant woman. The bill does The Unborn explicitly exclude Victims of abortion as a punViolence Act is ishable offence. one of the year’s But backers of top new issues for abortion rights abortion opposay that establishnents. The act Protected before birth ment of fetal would create a rights could nonetheless lead directly separate federal crime for the injury to the overturning of legalised to or death of an “unborn child” of a abortion in the USA. The American pregnant woman during the commisCivil Liberties Union called the sion of another federal crime against measure “a wolf in sheep’s clothing”. that woman. The measure defines an About half the states in the USA “unborn child” as a “child in-utero”, already have laws to punish those which in turn is defined as “a memguilty of killing the unborn children ber of the species homo sapiens at of pregnant women. But the majority any stage of development who is of those laws do not apply to all carried in the womb”. stages of pregnancy. Rather, they are Backers of the bill say that new triggered only in cases in which the penalties are needed, citing cases in fetus is past the point of viability, or which pregnant women have been at least past the point of attacked with the intent of terminat“quickening”. ing the pregnancy, while attackers have been subject only to punishment for assault on the woman herself. But Julie Rovner
T
US panel calls for funding of embryo research fter weighing the advice and opinions of scientists, policymakers, ethicists, patients, and religious leaders, the National Bioethics Advisory Commission (NBAC) recommended on Sept 13 that the US government begin funding researchers who want to derive and use stem cells from fetal tissue and human embryos that have been discarded after infertility procedures. This summer, the panel intimated it would make such a suggestion in its final report. So fireworks were expected when the report was released, because many anti-abortion activists firmly oppose the use of embryos and fetal tissue in research. But instead of having a planned press briefing, the NBAC quietly issued the report, which had been almost a year in the making. This move guaranteed little press coverage and threw the debate over to Congress, which must decide whether to lift a ban on using federal money for any research involving human embryos.
A
President Clinton has said the ban should stay. The National Institutes of Health (NIH) has been advised of a loophole in the ban allowing it to support researchers wanting to use embryonic stem cells, as long as they themselves did not derive the cells. The NIH is working on guidelines for grant proposals and research, but these too might be blocked by Congress. The NBAC has said both privately and publicly funded researchers should not be allowed to create embryos just to get stem cells. And, it has urged “an appropriate and open system of national oversight and review” for the research. But the presidentially appointed panel’s recommendations may not have any sway over Congress. John Gearhart (Johns Hopkins University, Baltimore, MD, USA), one of the first people to isolate stem cells, said, “I don’t think it’s going to have much impact on the debate”. Alicia Ault
1105
T
he Spanish Senate approved a motion on Sept 14 to expand its national palliative-care plan. The initiative was put forward by Enrique Bellido, president of the Senate Health Commission and a senator from the ruling Partido Popular party, who said that palliative care should erase from medical vocabulary the phrase that “there is nothing else to do for the patient”. When emphasising the necessity of such a plan to the Senate, Bellido noted that “current demographic and morbidity indicators foresee an increase in the number of patients with cancer and with chronic and degenerative pathologies mainly due to the progressively older age of the population”. The new plan will principally be based on guaranteeing palliative care for the terminally ill “in any place, circumstance, or situation, through appropriate health care, psychological, and social support and with no distinction of disease or actuation field”, said Bellido. The Partido Popular party agreed that it was also necessary to coordinate health care and social services so that palliative care is carried out mainly in patients’ homes, which are regarded as the best place to control a patient’s clinical outcome and treatment. Bellido noted that alongside health and social advantages, the plan should lead to important savings, such as a 75% decrease in the flow of such patients to emergency wards and a 50% decrease in their mean hospital stay. The reforms will also include better training aimed at different levels of health-care professionals, social workers, and patients’ families. Most senators agreed that palliative care would have to be considered a separate academic discipline because current training is insufficient. When the motion was approved, Coral Rodríguez senator of the Socialist Party immediately presented an amendment declaring that the plans constituted “an unusual discrediting” of the recently formed Special Commission for the Study of Euthanasia. The motion is now awaiting final approval from the government. Xavier Bosch
THE LANCET • Vol 354 • September 25, 1999
Congress considers bill to protect fetuses abortion-rights supporters—and the o the distress of supporters of Clinton administration—say that abortion rights, a key committee although they would back stronger of the US House of Representatives penalties for assaults on pregnant approved a bill on Sept 14 that would women, that can provide legal probe accomplished tections to fetuses without giving independent of legal rights to the those of the fetus. pregnant woman. The bill does The Unborn explicitly exclude Victims of abortion as a punViolence Act is ishable offence. one of the year’s But backers of top new issues for abortion rights abortion opposay that establishnents. The act Protected before birth ment of fetal would create a rights could nonetheless lead directly separate federal crime for the injury to the overturning of legalised to or death of an “unborn child” of a abortion in the USA. The American pregnant woman during the commisCivil Liberties Union called the sion of another federal crime against measure “a wolf in sheep’s clothing”. that woman. The measure defines an About half the states in the USA “unborn child” as a “child in-utero”, already have laws to punish those which in turn is defined as “a memguilty of killing the unborn children ber of the species homo sapiens at of pregnant women. But the majority any stage of development who is of those laws do not apply to all carried in the womb”. stages of pregnancy. Rather, they are Backers of the bill say that new triggered only in cases in which the penalties are needed, citing cases in fetus is past the point of viability, or which pregnant women have been at least past the point of attacked with the intent of terminat“quickening”. ing the pregnancy, while attackers have been subject only to punishment for assault on the woman herself. But Julie Rovner
T
US panel calls for funding of embryo research fter weighing the advice and opinions of scientists, policymakers, ethicists, patients, and religious leaders, the National Bioethics Advisory Commission (NBAC) recommended on Sept 13 that the US government begin funding researchers who want to derive and use stem cells from fetal tissue and human embryos that have been discarded after infertility procedures. This summer, the panel intimated it would make such a suggestion in its final report. So fireworks were expected when the report was released, because many anti-abortion activists firmly oppose the use of embryos and fetal tissue in research. But instead of having a planned press briefing, the NBAC quietly issued the report, which had been almost a year in the making. This move guaranteed little press coverage and threw the debate over to Congress, which must decide whether to lift a ban on using federal money for any research involving human embryos.
A
President Clinton has said the ban should stay. The National Institutes of Health (NIH) has been advised of a loophole in the ban allowing it to support researchers wanting to use embryonic stem cells, as long as they themselves did not derive the cells. The NIH is working on guidelines for grant proposals and research, but these too might be blocked by Congress. The NBAC has said both privately and publicly funded researchers should not be allowed to create embryos just to get stem cells. And, it has urged “an appropriate and open system of national oversight and review” for the research. But the presidentially appointed panel’s recommendations may not have any sway over Congress. John Gearhart (Johns Hopkins University, Baltimore, MD, USA), one of the first people to isolate stem cells, said, “I don’t think it’s going to have much impact on the debate”. Alicia Ault
1105